title: Validity of HAT score for predicting symptomatic intracranial hemorrhage in acute stroke patients with proximal occlusions: data from randomized trials of sonothrombolysis.
abstract: BACKGROUND
  The Hemorrhage after Thrombolysis (HAT) score has recently been introduced as a practical scale for risk stratification of intracranial hemorrhage (ICH) in patients receiving intravenous tissue plasminogen activator (tPA). We aimed to externally validate and evaluate the predictive ability of the HAT score in patients with proximal arterial occlusions (PAO) enrolled into randomized clinical trials of sonothrombolysis.
  
  
  METHODS
  The HAT score (range 0, minimum risk, to 5, maximum risk) was retrospectively calculated for each patient using clinical trial data (baseline NIHSS, extent of hypodensity on CT, history of diabetes mellitus and serum glucose). Symptomatic ICH (sICH) was defined as imaging evidence of ICH with clinical worsening (NIHSS ≥ 4) within 72 h from stroke onset. The predictive ability of the HAT score for sICH and any ICH (both asymptomatic and symptomatic) was calculated using c statistics.
  
  
  RESULTS
  A total of 161 tPA-treated patients (mean age 68 ± 13 years, 58% men, median NIHSS 16, interquartile range 9) with PAO were randomized in TUCSON (n = 35) and CLOTBUST (n = 126). sICH occurred in 9 (5.6%) cases, and 6 had asymptomatic ICH. The rates of sICH for the corresponding HAT scores were: HAT 0-1: 3%; 2: 9%; 3: 14%; 4-5: 14%. The risk of sICH (c statistic 0.72, 95% CI: 0.58-0.86; p = 0.027) and any ICH (c statistic 0.70, 95% CI: 0.58-0.82; p = 0.011) increased with higher HAT scores. Higher HAT scores were also associated with higher likelihood of persisting occlusion (c statistic 0.63, 95% CI: 0.54-0.72; p = 0.004).
  
  
  CONCLUSIONS
  The HAT score has reasonable external validity for predicting the risk of sICH following intravenous thrombolysis in patients with PAO. Moreover, higher HAT scores appear to be associated with higher likelihood of persisting occlusion in tPA-treated patients.
authors.affiliation: Comprehensive Stroke Center, University of Alabama at Birmingham Hospital, Birmingham, AL, USA. tsivgoulisgiorg@yahoo.gr
authors.forename: Georgios
authors.initials: G
authors.lastname: Tsivgoulis
authors.forename: Maher
authors.initials: M
authors.lastname: Saqqur
authors.forename: Andrew
authors.initials: A
authors.lastname: Barreto
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Demchuk
authors.forename: Marc
authors.initials: M
authors.lastname: Ribo
authors.forename: Marta
authors.initials: M
authors.lastname: Rubiera
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Sharma
authors.forename: Elefterios
authors.initials: E
authors.lastname: Stamboulis
authors.forename: Peter D
authors.initials: PD
authors.lastname: Schellinger
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Molina
authors.forename: Andrei V
authors.initials: AV
authors.lastname: Alexandrov
mesh_terms: D000368:Aged; D000465:Algorithms; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D001786:Blood Glucose / Q000378:metabolism; D002536:Cerebral Arteries; D002543:Cerebral Hemorrhage / Q000145:classification* / Q000175:diagnosis* / Q000209:etiology; D003920:Diabetes Mellitus / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014464:Ultrasonic Therapy
chemical_list: D001786:Blood Glucose; D010959:Tissue Plasminogen Activator